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Meta-Analysis
. 2017 Jan 18;1(1):CD010959.
doi: 10.1002/14651858.CD010959.pub2.

Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock

Brenda Ng Andriolo  1 , Regis B Andriolo  2 , Reinaldo Salomão  3 , Álvaro N Atallah  1
Affiliations
Meta-Analysis

Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock

Brenda Ng Andriolo et al. Cochrane Database Syst Rev. .

Abstract

Background: Serum procalcitonin (PCT) evaluation has been proposed for early diagnosis and accurate staging and to guide decisions regarding patients with sepsis, severe sepsis and septic shock, with possible reduction in mortality.

Objectives: To assess the effectiveness and safety of serum PCT evaluation for reducing mortality and duration of antimicrobial therapy in adults with sepsis, severe sepsis or septic shock.

Search methods: We searched the Central Register of Controlled Trials (CENTRAL; 2015, Issue 7); MEDLINE (1950 to July 2015); Embase (Ovid SP, 1980 to July 2015); Latin American Caribbean Health Sciences Literature (LILACS via BIREME, 1982 to July 2015); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO host, 1982 to July 2015), and trial registers (ISRCTN registry, ClinicalTrials.gov and CenterWatch, to July 2015). We reran the search in October 2016. We added three studies of interest to a list of 'Studies awaiting classification' and will incorporate these into formal review findings during the review update.

Selection criteria: We included only randomized controlled trials (RCTs) testing PCT-guided decisions in at least one of the comparison arms for adults (≥ 18 years old) with sepsis, severe sepsis or septic shock, according to international definitions and irrespective of the setting.

Data collection and analysis: Two review authors extracted study data and assessed the methodological quality of included studies. We conducted meta-analysis with random-effects models for the following primary outcomes: mortality and time spent receiving antimicrobial therapy in hospital and in the intensive care unit (ICU), as well as time spent on mechanical ventilation and change in antimicrobial regimen from a broad to a narrower spectrum.

Main results: We included 10 trials with 1215 participants. Low-quality evidence showed no significant differences in mortality at longest follow-up (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.65 to 1.01; I2 = 10%; 10 trials; N = 1156), at 28 days (RR 0.89, 95% CI 0.61 to 1.31; I2 = 0%; four trials; N = 316), at ICU discharge (RR 1.03, 95% CI 0.50 to 2.11; I2 = 49%; three trials; N = 506) and at hospital discharge (RR 0.98, 95% CI 0.75 to 1.27; I2 = 0%; seven trials; N = 805; moderate-quality evidence). However, mean time receiving antimicrobial therapy in the intervention groups was -1.28 days (95% CI to -1.95 to -0.61; I2 = 86%; four trials; N = 313; very low-quality evidence). No primary study has analysed the change in antimicrobial regimen from a broad to a narrower spectrum.

Authors' conclusions: Up-to-date evidence of very low to moderate quality, with insufficient sample power per outcome, does not clearly support the use of procalcitonin-guided antimicrobial therapy to minimize mortality, mechanical ventilation, clinical severity, reinfection or duration of antimicrobial therapy of patients with septic conditions.

PubMed Disclaimer

Conflict of interest statement

Brenda NG Andriolo: none known.

Régis B Andriolo: none known.

Reinaldo Salomão: none known.

Álvaro N Atallah: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Trial sequential analysis for mortality at longest follow‐up (available data analysis).
5
5
Funnel plot of comparison: 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), outcome: 1.1 Mortality at longest follow‐up.
6
6
Sensitivity analysis including Bouadma 2010, Jensen 2011 and Layios 2012: 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), outcome: 1.1 Mortality at longest follow‐up (Analysis 1.1).
7
7
Sensitivity analysis including Bouadma 2010 and Jensen 2011: 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), outcome: 1.2 Mortality at 28 days (Analysis 1.2).
8
8
Sensitivity analysis including Layios 2012: 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), outcome: 1.3 Mortality at ICU discharge (Analysis 1.3).
1.1
1.1. Analysis
Comparison 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), Outcome 1 Mortality at longest follow‐up.
1.2
1.2. Analysis
Comparison 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), Outcome 2 Mortality at 28 days.
1.3
1.3. Analysis
Comparison 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), Outcome 3 Mortality at ICU discharge.
1.4
1.4. Analysis
Comparison 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), Outcome 4 Mortality at hospital discharge.
1.5
1.5. Analysis
Comparison 1 PCT versus non‐PCT (standard care or CRP: primary outcomes), Outcome 5 Time receiving antimicrobial therapy (days) ‐ mean (SD).
2.2
2.2. Analysis
Comparison 2 PCT versus non‐PCT (standard care or CRP: secondary outcomes), Outcome 2 ICU length of stay (days) ‐ mean (SD).
2.9
2.9. Analysis
Comparison 2 PCT versus non‐PCT (standard care or CRP: secondary outcomes), Outcome 9 Reinfection (primary infection relapse).
3.4
3.4. Analysis
Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 4 Sepsis‐related death*.
3.22
3.22. Analysis
Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 22 Nosocomial infection.
3.38
3.38. Analysis
Comparison 3 PCT versus non‐PCT ‐ other outcomes of potential interest, Outcome 38 Clinical cure*.
4.1
4.1. Analysis
Comparison 4 PCT versus non‐PCT (standard care or CRP: ITT analysis), Outcome 1 Mortality at longest follow‐up (imputing mortality for missing participants).
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD010959

References

References to studies included in this review

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Bloos 2016 {published data only}
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